A few weeks ago, a 62-year-old man came in for a followup after recent hospitalization for a mini stroke. He has now recovered seemingly without any residual weakness of the limbs.
"But my memory is all messed up," he said. "I can't seem to get the right words out … sometimes the names of people I know well just escape me." I reviewed his hospital charts and the neurologist had made a notation that the man may have had multiple mini strokes before, and that would explain his progressive deterioration of memory. In other words, he was exhibiting symptoms of some degree of vascular dementia.
"Do you smoke much?" I asked, and he promptly answered, "I used to … up to a pack and a half a day for the past 35 years, but I quit. Now I smoke only e-cigarettes."
"E-cigarettes? Why? They are also not good for your health," I said.
"Really! I thought I could replace the cigarettes with e-cigarettes. Aren't they harmless?" he asked. "I thought this would help me quit my smoking habit."
That's how most people start with electronic cigarettes. But instead of stopping after a few days or weeks, once the craving for real cigarettes is gone, they continue to smoke e-cigarettes, not knowing they can also be potentially harmful. E-cigarettes contain nicotine, a powerfully addictive agent.
Essentially, an e-cigarette is a small cartridge that holds a liquid solution containing varying amounts of nicotine, flavorings and other chemicals, a heating device or vaporizer and a battery for power.
Apart from the popular e-cigarettes, there are also e-pipes, e-hookah and e-cigars for your smoking, or shall we say "vaping," pleasure. All these Electronic Nicotine Delivery Systems, or ENDS, are designed to deliver nicotine in vapor form that is inhaled.
E-cigarettes have become the rage among teens and young adults, and the ENDS business has mushroomed into a billion-dollar enterprise, ready to take over from the traditional tobacco industry.
But are e-cigarettes safe? Although there's some debate among health experts, data about the harmful effects of e-cigarettes is emerging slowly. It appears that all the damage from tobacco cigarettes that we have been trying to prevent will now be reproduced by e-cigarette smoking.
When cigarettes were first introduced some 100 years ago, they were thought to be harmless. When it became apparent after several decades of use that cigarettes can cause widespread injury to the body, in some cases leading to cancer, heart attacks and strokes, the surgeon general came out with the warning that smoking is hazardous to your health. Now the same story is likely to be repeated with e-cigarettes.
Cigarette smoking remains the leading preventable cause for morbidity and mortality in the United States, accounting for more than 480,000 deaths a year, according to the Centers for Disease Control and Prevention. Thankfully, regular cigarette use has declined in recent years; the latest statistics reveal only 15 percent of adults smoke. We may have achieved a historic nadir in smoking cessation with its attendant health benefits, but with the popularity of e-cigarettes skyrocketing, these hard-won successes may soon be erased.
The nictotine in e-cigarettes is an incredibly addictive substance with potentially harmful vascular and neurologic effects. Nicotine can increase the production of catecholamine, a hormone that raises heart rate and blood pressure. Research presented at the European Society for Cardiology Congress in August found that the habitual use of e-cigarettes "adversely impacts the main artery of the heart, aorta, increasing its stiffness that in turn increases the workload of heart." Recent studies also show that nicotine inhalation alone has the power to cause artery constriction and harm to the lining of the arteries, leading to adverse cardiac events. In addition, the vapor from the heated liquid nicotine in some brands contains cancer-causing substances like formaldehyde and acetaldehyde.
E-cigarettes are being promoted as a means to wean smokers off combustible tobacco, but there is no proof that they are an effective quit aid. On top of that, they pose grave danger as gateways to lifelong e-cigarette addiction. In other words, one addiction is being replaced by another.
Another worry is that e-cigarettes may serve as an introductory product for young people who are likely to move on to real cigarettes later.
Until earlier this year, there was no federal oversight of the manufacture and marketing of ENDS. In May, the U.S. Food and Drug Administration's regulatory authority was expanded to cover all tobacco products, including e-cicarettes, e-pipes and all other ENDS. As the use of such products escalates, with great potential for adverse health consequences, the importance of FDA regulation and control cannot be overemphasized.
We have already seen the devastation caused by tobacco smoking, and we don't want to witness a repeat with e-cigarettes. If you are an e-cigarette smoker, now is the time to quit. If you aren't, don't start.
Dr. M. P. Ravindra Nathan is a cardiologist with Crescent Community Clinic in Spring Hill.